Adequate Vitamin D and Sun Exposure Protection for Children
by deborah ziebarthMSN, RN, PhD Candidate
Outdoor play is always important for children, but now that we are in the middle of summer every nanny must answer this important question: how much sun is too much sun? Sunlight is essential for vitamin D synthesis in children. However, the sun's ultraviolet rays can cause harm. It is estimated that approximately 25% of lifetime sun exposure occurs before the age of 18. So how do we protect children from the effects of sun exposure while ensuring adequate vitamin D intake? Let’s look at this problem from both perspectives: adequate vitamin D and sun exposure protection.
Adequate vitamin D is needed for bone health in children. The main source of vitamin D is exposure to sunlight. Vitamin D deficiency, or hypovitaminosis D, is common among American children. Data from the 2000–2004 National Health and Nutrition Examination Survey (NHANES) indicates that approximately 15% of children between the ages of 6 and 11 and 8% of children ages 1 to 5 have a vitamin D deficiency. Sun exposure and vitamin D status are intertwined. However, the American Academy of Dermatology has stated that maximum production of vitamin D occurs after only brief sun exposure: 2 to 5 minutes of midday sun exposure. Leaders in skin cancer prevention agree that vitamin D is important for good health, but they oppose intentional sun exposure to induce vitamin D production. Instead of deliberately exposing children to the sun to maintain vitamin D sufficiency, experts recommend renewed attention to dietary and supplemental sources of vitamin D. Dietary sources of vitamin D include fortified milk and fish. A daily intake of 400 IU of vitamin D will prevent vitamin D deficiency rickets in infants. Amounts of vitamin D necessary to support optimal health in older children and adolescents are less clear. Consult a pediatrician for recommended dosages of vitamin D supplements.
Sun Exposure Protection
The sunlight that reaches us is made up of two types of harmful rays: long wave 95% ultraviolet A (UVA) and short wave 5% ultraviolet B (UVB). Basically, UVA rays can age us and UVB rays can burn us. Overexposure to either rays can damage the skin and cause cancer. Studies have documented an increase in the incidence of melanoma in children and adolescents. From 1973 to 2001, the incidence of melanoma in American children younger than 20 years old increased 2.9% annually. Leading organizations (the American Cancer Society, Centers for Disease Control and Prevention, Healthy People, National Council on Skin Cancer Prevention) have recommended these sun-safe behaviors:
- Do not burn; avoid sun tanning.
- Wear protective clothing and hats.
- Wear sunglasses.
- Seek shade.
- Use extra caution near water, snow, and sand.
- Apply sunscreen.
Clothing, Hats, and Sunglasses
Clothing offers a simple means of sun protection. In contrast to sunscreens, the protection afforded by clothing does not diminish throughout the day unless the clothing becomes wet. Infants and children should be dressed in cool, comfortable clothing and wear hats with brims. Hats provide variable sun protection for the head and neck, depending on the brim width, material, and weave. Sunglasses for infants and children are suggested.
Infants younger than 6 months should be kept out of direct sunlight. Whenever possible, children's outdoor activities should be planned to minimize peak intensity midday sun (10 a.m. to 4 p.m.). Seeking shade is somewhat useful, but children can still burn even in the shade because light is scattered and reflected.
Sunscreen is the main form of protection used. The American Academy of Pediatrics has stated that sunscreen may be used on infants as young as 6 months on small areas of skin if adequate clothing and shade are not available. Sunscreens reduce the intensity of ultraviolet rays. The formulating, testing, and labeling of sunscreen products is regulated by the FDA. The FDA has approved 17 sunscreen chemicals for use in the United States.
SPF is a grading system developed to quantify the degree of protection from erythema provided by using a sunscreen; the higher the SPF, the greater the protection. For example, a person who would normally experience sunburn in ten minutes can be protected up to approximately 150 minutes (10 × 15) with an SPF15 sunscreen.
The Ultraviolet (UV) Index
The UV index predicts the intensity of UV light for the following day on the basis of the sun's position, cloud movements, altitude, ozone data, and other factors. The index is available online for thousands of cities at www.weather.com. It is printed in the weather section of many daily newspapers and reported through weather reports of local radio, television, and weather stations. The UV index can be used to plan outdoor activities.
Be Smart about Vitamin D and the Sun
So while it is important for children to get sufficient vitamin D, deliberate sun exposure is not the best solution. In fact, lifelong sun protection is recommended beginning at an early age. Although sunscreen is the most commonly used method of sun protection, a complete program of sun protection should be used to protect children of all ages. That includes wearing clothing and hats, timing activities to minimize peak hours of the sun, and wearing sunglasses. It’s up to you to protect the next generation from the sun and the harm it can induce.
Journal of American Academy of Pediatrics. Technical Report: Ultraviolet Radiation: A Hazard to Children and Adolescents (2011)